Peritoneal lavage for severe acute pancreatitis: a systematic review of randomised trials

Abstract

Background: The use of peritoneal lavage in patients with acute pancreatitis remains controversial. While recent guidelines do not make a positive recommendation for its use, there continues to be reports of clinical benefits from peritoneal lavage in this setting. The aim of this study was to systematically review the available randomized controlled trials of peritoneal lavage in patients with severe acute pancreatitis.

Methods: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and four major Chinese biomedical databases were searched. A random effects model was used in meta-analysis. The summary estimates were reported as risk ratios (RR) with corresponding 95% confidence interval.

Results: Ten randomized controlled trials, encompassing a total of 469 patients, were included. When compared with conservative treatment, the use of peritoneal lavage did not result in a statistically significant difference in the risk of mortality (RR = 0.82; 95% CI 0.32-1.79; p = 0.69) and complications (RR = 1.33; 95% CI 0.99-2.12; p = 0.06). The use of peritoneal lavage with antiproteases, in comparison with peritoneal lavage only, also did not result in a statistically significant difference in the risk of mortality and complications.

Conclusion: The lavage of the peritoneal cavity in patients with severe acute pancreatitis does not appear to confer a clinical benefit. Whether lavage of the pancreatic bed after necrosectomy is beneficial has yet to be determined.